Healthcare Provider Details

I. General information

NPI: 1356038392
Provider Name (Legal Business Name): KOWALSKI DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 10/27/2024
Certification Date: 10/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 44TH STREET SE, ST 203
KENTWOOD MI
49512
US

IV. Provider business mailing address

2450 44TH STREET SE, ST 203
KENTWOOD MI
49512
US

V. Phone/Fax

Practice location:
  • Phone: 810-623-2747
  • Fax:
Mailing address:
  • Phone: 810-623-2747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. EVAN JOSEPH KOWALSKI
Title or Position: MEMBER
Credential: DDS
Phone: 810-623-2747